I received an email one morning asking if I was available that week to interview with them. I said I was very interested and sent along the link to my blog so they could get to know me a bit before we met. Leslie, Fred, and Leslie’s mother, Alice, read several of the stories I had posted on the blog, many of which are now included in this book.
I agreed to meet Leslie later that week at a nearby coffee shop. We hit it off right away. We asked each other lots of questions and talked and, before we knew it, two hours had passed. I told her that she could let me know the following week either way and explained that I would email them a contract to go over should they wish to continue with me. We hugged goodbye and she assured me she would be in touch.
We got together the following week, this time with Fred and Alice. We talked about what services I could offer and went over what a doula does and does not do. Then we watched Doula: a Documentary, to give them more information about the options available.
Our last prenatal appointment finally arrived. This was it. The next time I would see them would be in the hospital. We were excited, nervous, and very encouraged that this little guy had made it this far. And he wasn’t tiny, either. The doctor guessed him to be around eight pounds. He also began to question Leslie’s ability to birth such a big baby. He ordered a further ultrasound and explained to the couple that Leslie had a narrow pelvis. The doctor knew they wanted a water birth and definitely a natural, unmedicated birth, but now he felt he had to share some of his concerns. He was absolutely willing to let her try a vaginal birth but wanted to prepare them should they run into true cephalopelvic disproportion (CPD), a dynamic that indicates that the size of the baby’s head is different from the size of the pelvis and signals a lack of the proper relationship between the two factors. CPD occurs when a baby’s head or body is too large to fit through the mother’s pelvis, despite allowing ample time to mold. Her baby had also been breech, or head up and feet- or butt-first before the last appointment, but then it was confirmed that he had indeed turned around all on his own. I had told Leslie that I had complete confidence that her body had grown this baby and would now also know how to birth him.
During the next week Leslie was feeling contractions on and off, usually picking up in the evening, though none progressed into a real labor pattern. We talked by phone daily. My main job was to remind her that she would not always be pregnant. I encouraged her to eat, rest, and take walks and I told her I knew he would come . . . on his birthday. I told her I had no doubt. Then she had another prenatal appointment on Friday.
First it confirmed the baby was still head down. Good baby. Because of the combination of some of the medical issues they were dealing with, the doctor explained that he was not comfortable waiting for labor to start after the due date. He felt he should intercede in the next few days, citing some very valid studies that said the placenta will sometimes not do very well given the concerns they were dealing with, and he was not willing to wait until problems presented themselves. He scheduled an induction for the following Wednesday evening. He proposed first using a prostaglandin medication to ripen the cervix. It would be inserted and left there for twelve hours, preferably while Leslie slept. Then on Thursday morning Pitocin would be used to encourage contractions, and labor, hopefully, would kick-in soon thereafter. (In some rare cases the first medication alone is enough to turn labor on.)
I did not know it at the time but Leslie had quite a track record for being one of those rare cases where nothing that came next was ever written in any textbook. Her mother and Fred were going to stay overnight with her in the hospital Wednesday night and I would join them by 8:00 a.m. unless, of course, they wanted me to come earlier. By 3:00 a.m. Leslie was having some really good rushes about five minutes apart. She had been only one centimeter dilated when they put in the prostaglandin the night before. They wouldn’t check her again until they removed it at 8:30 a.m.
I arrived shortly after 6:00 a.m. and helped her with her breathing. We breathed together, “slowly . . . in . . . now out . . . relax your shoulders . . . relax your jaw . . . You are doing great!” I was excited too. This was the real thing. We were going to see this little big guy soon. Leslie was doing amazingly well hour after hour. She could write the book about relaxing in labor.
At 8:30 a.m. the nurse checked her—still one centimeter. I told her that I wasn’t at all discouraged. This was not a normal labor—yet. It was an induction. All the different parts had to come together in order to progress to the next stage. She needed to eat now, rest, visit the bathroom, and walk. I showed Fred how to support her with the next rush and sway or dance from side to side to help her baby move down. She had been working so hard with the contractions, I was a bit mystified.
The next time the nurse checked her she could not feel the baby’s head. Had he slipped up further from the pelvis? She wasn’t sure. She called the doctor, who recommended starting some Pitocin to try to strengthen the contractions and hopefully start her dilating and moving into active labor.
Four hours later the nurse found the cervix to still be at one centimeter. This wasn’t going anywhere. Then Leslie said, “I just heard a pop. My water bag broke!” We continued breathing and trying to relax, one rush . . . at . . . a . . . time. The nurse returned with an ultrasound machine and proceeded to try to map out where the baby was. She went back and forth and up and then down with the gooey wand. We were all watching, hoping to get a good look at him. She finally gave the wand to another nurse, who started scanning higher up this time. As she did, I saw the baby’s head clearly silhouetted. I blurted out, “He’s breech!” The nurse simply nodded and wheeled the machine out into the hall, the other nurse following close behind. While I grabbed a towel and wiped off her sticky belly, Leslie started sobbing.
The Pitocin was stopped and her doctor was called. When he arrived he said he was as surprised as the rest of us. He was not prepared to offer a vaginal birth now, especially since he was already wondering about the size of the pelvis. He was also surprised that, in spite of the water bag having broken, somewhere in the last few hours it appeared the baby had turned around. Again. Why would he do that? He said that the chances of that happening were far less than three to four percent. Leave it to Leslie to be off the grid.
Looking back on this series of events, I can only wonder, did he at least try to engage his head and, finding it wasn’t possible, decide to attempt to come feet first? Did he have any idea that the first option was simply impossible? Do babies have some kind of innate ability to conform to the particular circumstances? Does nature adapt? Did She make a mistake this time? Or was this part of some divine, exquisitely intuitive plan?
Because her membranes had ruptured, we were past the point where the doctor could try to turn the baby. He had actually been thinking on the drive to the hospital that he would offer that as an option (good man). He also did not realize until he arrived that the contractions were still continuing to intensify, even with the Pitocin stopped. He discussed the options remaining to the couple and together they decided on a Cesarean section, not the water birth they had so carefully planned. All those hours writing a birth plan, the long weeks of hoping, months of planning, hours watching water births on the Internet—all culminated in this moment when all control was removed from their hands. We were all crying at his point—Fred, Alice, Leslie, and me. How could we get back to focusing on their precious baby about to be born?
I gently tried to tell her she would be holding her little one soon. I assured Leslie that she had done a valiant job and could not have done more. Two nurses returned and went into action. There was a whole list of protocols now to run through: papers to sign, shaving her lower belly, drinking the antacid cocktail, etc.
I had noticed throughout the day how connected Leslie and her mother were and decided to bring up the subject then about who would go into the operating room with her. The nurse had tossed two sets of scrubs onto
the bedstand and I told Fred that we needed to get ready. While the anesthesiologist was talking with Leslie, I took her mother aside and asked if she would like to go in as her doula.
She jumped at the idea. She was about to see her first grandchild being born. There very well might never be another chance like this one. I told her if anyone questioned her, she should say she was a doula in training, besides being her mom. It worked.
I have always gone into the operating room with my clients when they needed a C-section. I have been able to make sure that the baby is brought sooner, rather than later, to his mama to hold or even nurse. If there isn’t a partner with her, I make sure we get some good pictures and let Mom know how her baby is doing while he is on the warmer until he can be with her. Afterward, it is important to talk about what happened and why. It is hard to process the chain of events sometimes. Often a woman feels like she has somehow failed if she needs a C-section and I want to have this discussion to reinforce the fact that she was a total success and that she did everything in her power to birth her baby but that certain things happened and we had to deal with them as they came up.
I remind her that this is now the land of parenthood, where there are curves in the road, there are exceptions to every rule, and even our best-laid plans are apt to be foiled in the blink of an eye. This land is not always very fair, or forgiving, and we cannot see the future. As one wise woman once said about the land of birth, “Meconium happens.”
So I didn’t go into the OR, but used the time to clean up the room and grab some food. Leslie would be returning to the same room after only an hour in recovery. I prayed too that it would all be okay. I was anxious to meet this little man who had such an unorthodox way of coming into the world. I had never seen anything quite like it before, even after more than thirty years in birth work.
Finally, Alice came back to the room, absolutely radiant, followed soon after by a nurse wheeling the baby in. I took one look. He was beautiful and he was huge! He weighed in at ten pounds, seven ounces. Leslie was soon brought back with the proud dad. It was over. We hugged all around, crying happy tears this time, so relieved that everyone was here safe and sound. Every time I looked at the baby I marveled at how this had all played out. Could he have known he would not fit head first? What would this birth have looked like in Tanzania or Zimbabwe? Or even if he had been born in the last century here in this country? Would either of them have survived? I continued to ponder these things in my mind as I got ready to leave later that evening.
But he was here and healthy, and his parents were very relieved and happy. And exhausted. Before leaving I reminded Fred to protect mother and baby in the next few days and not let her get overwhelmed with visitors. I told him in no uncertain terms that the space around her was sacred and it was his job to protect it; their families could descend upon them next week, or better yet, the week after that, but not now. He agreed and gave me a big hug goodbye.
“There is a secret in our culture, and it’s not that birth is painful. It’s that women are strong.”
~Laura Stavoe Harm
Chapter 12: “Can I Keep Her Forever and Always?”
I never thought we would “click” at all. Everything was wrong from our first appointment. China complained about how awful pregnancy was. She accused her baby of hating her—why else would he kick her so much? She told me she was having this baby with the wrong man. She confided that he was a loser and she hated him; he couldn’t even find them decent housing. They were homeless and camping out at his sister’s house.
If she blames her baby for her discomfort now, what will labor look like? I wondered. And she says she wants a natural birth.
Then after the hospital tour that OB patients were offered she called to tell me that the hospital was all wrong. She could not, would not bring her baby into the world in such a depressing place—I had to find her a better hospital. They didn’t even have pictures in the rooms! I thought, Sweetheart, you’re not gonna care what’s on the walls when the time comes.
I called my supervisor at that point, asking for some wisdom. Was I the right doula for this client? Would she be happier with someone younger? Debby told me she wouldn’t choose that particular hospital either, saying, “It is depressing.”
Okay. I’d keep her.
I started going to prenatal visits with China. I needed to get to know her better. I gave her the phone numbers for some of the birthing centers throughout the city. She visited one that was absolutely gorgeous, but they were not a nonprofit and subsidized their medical assistance payments from low-income families by charging an additional $300 in cash up front. I told her I would find a place for her.
I called some of the other birth centers and found out that most did not take transfer clients after their thirty-fourth week. I knew I could probably get her into the midwife program at a local public hospital, but imagined she would be turned off by their “public” image. It is often seriously overcrowded, usually very loud, with standing room only in the emergency waiting room no matter what time of day or night it is. I called them and asked for the labor and delivery charge nurse. I explained who I was and what I was hoping to do for China. She explained that it was too late to transfer, but she actually knew who I was from some of the births I had been to there and asked if I would hold while she checked with the floor supervisor. She came back on the line and told me that if I could get China to the clinic the next day they would take her. I asked if I could also tour the labor and delivery area with her and silently hoped that their “better” rooms would be unoccupied so she could see them.
The next hurdle was getting her there. Medical Assistance will provide a taxi for medical appointments but only if scheduled two days in advance. I don’t drive so I was trying to figure out how to get her there in the morning. They were staying with her boyfriend’s sister in a suburb where the buses only run once an hour. It had been below zero all week with wind chill factors in the thirty-below range. Buses were out. I called Medical Assistance’s transportation number and told them that one of my clients had to get special emergency clearance to get next-day rides from here on out until she delivered. They actually approved her if I would arrange the rides for her. Great! It worked.
The next day we were in a tiny cubicle waiting for the midwife. China must have gotten out on the wrong side of the bed that morning because the first thing she did when the midwife came in was demand that she be induced! She said she was sick of being pregnant and miserable, couldn’t eat or sleep, that her baby hated her and kicked her on purpose, and that she would only stay if they got the delivery rolling . . . today!
The midwife listened and, skirting the issue completely, asked if China would kindly jump up on the table so we could hear her baby. The midwife and I both gushed about how wonderfully strong her baby’s heartbeat was when the Doppler was turned on. China just kept griping. I had had enough so I said to her, “You know, I have had ladies in the past year whose babies couldn’t move like yours can. I even had one baby who was born with half a heart. You have a really healthy baby, and I am really looking forward to seeing him, too!” The midwife was nodding her agreement the whole time.
We finished with the appointment and the midwife explained that it was not their policy to induce labor without a good medical reason, such as when the mother has preeclampsia or diabetes. China grouched a bit more but realized the two of us were not going to be moved on this one.
We walked through the midwives’ labor and delivery side of the hospital wing then, starting with a huge open room, almost a suite, with a birthing tub, private bathroom, little refrigerator and, yes, pictures on the walls. We saw two more rooms, decorated sparsely but pretty. They passed her royal highness’s inspection. Whew! I thanked the midwife profusely and we left to wait for the return taxi.
Talk about an attitude! Maybe she was feeling so very helpless being homeless and without sup
port that she had decided to demand her rights to the tiniest things that perhaps she could have control over. She was twenty-three going on twelve.
Then it dawned on me—I would gain her confidence with love. The expression, “Kill them with kindness” came to mind. I would lay it on so thick she wouldn’t know what hit her. I would smother her with kindness. I couldn’t imagine how else we would be able to work together through this birth. I knew she didn’t have a clue how hard it was going to be. And I didn’t want to see her fall apart before she even got into active labor and had to actually work to birth her baby.
My supervisor suggested I show China a book from our library called Bonding With Your Baby Prenatally, which I had brought along. I gave it to her as I hugged her goodbye that morning. It was almost Christmas.
The following week I collected all sorts of baby clothes and wrapped up a beautiful new scarf a friend had just given me. I already had four others so I thought it was just the right thing to give her. My old heroine Dorothy Day once said that, “The extra coat hanging in your closet actually belongs to the poor.” I decided this must apply to scarves, too.
The following week I was given donations to give to some of my mothers, so I started another care package for China. She was charmed, to say the least. And we even got along well enough to talk about a birth plan and her wishes. That was better, but when I asked if she wanted her boyfriend in the room at all she said, “He is gonna be there the whole time and see what he did to me!” Oh dear, not a good reason to add him to the birth plan.
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